Svetanoff Wendy Jo, Dekonenko Charlene, Dorman Robert M, Osuchukwu Obiyo, Carrasco Alonso, Gatti John M, Rentea Rebecca M
Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
Department of Urology, Children's Mercy Hospital, Kansas City, MO.
J Surg Res. 2020 Oct;254:247-254. doi: 10.1016/j.jss.2020.04.033. Epub 2020 May 29.
A successful flush is the ability to flush through the appendicostomy or cecostomy channel, empty the flush through the colon, and achieve fecal cleanliness. We evaluated our experience with patients who were having flush difficulties based on a designed algorithm.
Eight patients with flush difficulties were initially evaluated. Based on the need for additional surgery versus changes in bowel management therapy (BMT), we developed an algorithm to guide future management. The algorithm divided flush issues into before, during, and after flushing. Children aged <20 y who presented with flush issues from September 2018 to August 2019 were evaluated to determine our algorithm's efficacy. Specific outcomes analyzed included changes in BMT versus need for additional surgery.
After algorithm creation, 29 patients were evaluated for flush issues. The median age was 8.4 y (interquartile range: 6, 14); 66% (n = 19) were men. Underlying diagnoses included anorectal malformations (n = 17), functional constipation (n = 7), Hirschsprung's disease (n = 2), spina bifida (n = 2), and prune belly (n = 1). A total of 35 flush issues/complaints were noted: 29% before the flush, 9% during the flush, and 63% after the flush. Eighty percent of issues before the flush required surgical intervention, wherease 92% of issues during or after the flush were managed with changes in BMT.
Most flush issues respond to changes in BMT. This algorithm can help delineate which types of flush issues would benefit from surgical intervention and what problems might be present if patients are not responding to changes in their flush regimen.
成功的冲洗是指能够通过阑尾造口术或盲肠造口通道进行冲洗，通过结肠排空冲洗液，并实现粪便清洁。我们根据设计的算法评估了我们在冲洗困难患者方面的经验。
最初评估了8例冲洗困难的患者。基于是否需要额外手术与肠道管理治疗（BMT）的变化，我们开发了一种算法来指导未来的管理。该算法将冲洗问题分为冲洗前、冲洗中和冲洗后。对2018年9月至2019年8月出现冲洗问题的年龄<20岁的儿童进行评估，以确定我们算法的疗效。分析的具体结果包括BMT的变化与额外手术需求。
在创建算法后，对29例患者的冲洗问题进行了评估。中位年龄为8.4岁（四分位间距：6，14）；66%（n = 19）为男性。潜在诊断包括肛门直肠畸形（n = 17）、功能性便秘（n = 7）、先天性巨结肠（n = 2）、脊柱裂（n = 2）和梨状腹综合征（n = 1）。共记录了35个冲洗问题/投诉：冲洗前29%，冲洗中9%，冲洗后63%。冲洗前80%的问题需要手术干预，而冲洗中或冲洗后92%的问题通过BMT的改变进行处理。
大多数冲洗问题可通过BMT的改变得到解决。该算法有助于确定哪些类型的冲洗问题将从手术干预中获益，以及如果患者对冲洗方案的改变无反应可能存在哪些问题。
